In intensivecare units (ICUs) inanimate surfaces and equipment may be contaminated by nosocomial pathogens, including multi-drug resistant microorganisms.To assess the degree ... identical strains among patients, environment and hands isolates.This study reveals widespread contamination of the ICU environment with clinically relevant pathogens, including multidrug-resistant microorganisms despite cleaning and ...
Poisoning represents a significant part of admissions to intensivecare units... Register, and The Cause of Death Register).The incidence of ICU-treated poisonings was 43/100,000... The 30-day mortality was 2.7%, a majority died from poisoning (P < 0.01).In Sweden, patients treated in the ICU due to poisoning represent a fifth of all poisoned patients seeking medical care ...
AbstractText: To independently validate the predictive value of the intensivecare requirement score (IRS) in unselected poisoned patients AbstractText: Retrospective chart review AbstractText: Five hundred and seventeen out of 585 admissions for acute intoxications could be analyzed. Eleven were excluded for a condition already requiring intensive care unit (ICU) support at admission (e.g., preclinical intubation.
... To investigate the clinical value of early hemoperfusion (HP) in emergency treatment of carbamazepine (CBZ) poisoning AbstractText: 104 patients with acute CBZ poisoning treated from August 2004 to October 2015 in the Emergency Department were reviewed ... Initiation of HP in the early treatment stage of CBZ poisoning upon admission to an emergency department can significantly reduce the plasma concentration and retention period ...
Neuroscience (1) Poisoning (4), Coma (2), Respiratory Depression (1), more mentions
... fluid and urine specimens using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) in a population of heroin users presenting to the Emergency Department after overdose.This was a prospective observational study of adult Emergency Department patients who presented after a reported heroin overdose requiring naloxone administration.
... and via its online poisoning information and management database, TOXBASE(®) AbstractText: To demonstrate the impact of NPIS telephone advice and TOXBASE(®) guidance on poisoning-related referrals to emergency departments (ED) from primary healthcare settings AbstractText: A telephone survey of primary healthcare providers calling the NPIS and an online survey of TOXBASE ...
We aimed at identifying waterpipe smoking as a cause for carbon monoxide poisoning in a large criticalcare database of a specialty care referral center.This retrospective cohort study included patients with a history of exposure to waterpipe smoking and carbon monoxide blood gas levels >10% or presence of clinical ...
Carbon Monoxide Poisoning (4), Poisoning (2), Unconsciousness (1), more mentions
BACKGROUND: Electronic dance music (EDM) festivals are increasingly common and psychoactive substance use is prevalent. Although prehospital care can obviate the transfer of many attendees to health care facilities (HCFs), little is known regarding the emergency department (ED) burden of patients presenting from EDM festivals.
OBJECTIVES: This study describes the patient volume, length of stay (LOS), and presenting complaints of patients from a 3-day EDM festival in close proximity to an area ED.
METHODS: Medical charts of patients presenting to one HCF from an EDM festival were reviewed for substances used, ED LOS, and sedative medications administered. Additionally, preparedness techniques are described.
RESULTS: Over the 3-day festival, 28 patients presented to the ED (median age 21 years; range 18-29 years). Twenty-five had complaints related to substance use including ethanol (n = 18), "molly" or "ecstasy" (n = 13), and marijuana (n = 8). Three patients required intensive care or step-down unit admission for endotracheal intubation, rhabdomyolysis, and protracted altered mental status. The median LOS for discharged patients was 265 min (interquartile range 210-347 min). Eleven patients required the use of sedative medications, with cumulative doses of 42 mg of lorazepam and 350 mg of ketamine. All patients presented within the hours of 5:00 pm and 2:15 am.
CONCLUSION: The majority of ED visits from an EDM festival were related to substance use. ED arrival times clustered during the evening and were associated with prolonged LOS. Few patients required hospital admission, but admitted patients required high levels of care. HCFs should use these data as a guide in planning for future events.
BACKGROUND: Diabetes mellitus is a disease that affects millions of Americans, and its prevalence is only anticipated to increase in coming years. It is estimated that diabetes-related visits account for 1% of all emergency department (ED) encounters. In recent years, there have been several new categories of medications approved for the treatment of diabetes, including new insulins, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, an amylin analogue, and sodium-glucose cotransporter-2 inhibitors.
OBJECTIVE OF THE REVIEW: This review presents recently approved agents to treat diabetes, with a focus on basic mechanism, place in therapy, and toxicities the ED provider may encounter.
DISCUSSION: Many of these new therapies have been incorporated as first- and second-line agents for the management of diabetes. Recently approved diabetes medications often have different mechanisms of action and adverse effect and overdose profiles compared to traditional agents, such as sulfonylureas and metformin.
CONCLUSIONS: Emergency providers will encounter patients taking these newly approved medications, as well as treat those presenting with adverse effects and overdoses from them. As such, emergency providers must have a basic understanding of these new therapies so that they can optimally care for diabetic patients.
Endocrine Disorders (7), Men's Health (2) Diabetes Mellitus (7), more mentions
Extracorporeal membrane oxygenation (ECMO) is being increasingly used for patients with severe ARDS refractory to otherwise conventional management. A 29year old male arrived with Emergency Medical Services (EMS) status post presumed heroin overdose. He was administered Naloxone 2mg intravenously prior to arrival in the emergency department. The patient arrived in severe respiratory distress with a pulse oximetry level of 50 ...
Adult Respiratory Distress Syndrome (2), Respiratory Failure (1), more mentions
... environment to patients is rapid AbstractText: To understand the intra-hospital dynamics of C. auris transmission and to determine the possible interventions to prevent its spread AbstractText: Surveillance of intensivecare units was carried out to assess patient colonization, environmentalcontamination and hand carriage of the yeast among healthcare workers.
OBJECTIVE: Inadequate stocking of essential antidotes in hospitals is an internationally documented problem. A concrete and sustainable system-wide solution for easy access to antidotes in emergency departments (EDs) was developed and implemented in Nova Scotia, Canada.
METHODS: Antidote stocking guidelines and a systemwide antidote management strategy were established. A standardized collection of antidotes housed in highly visible containers in provincial EDs was implemented for timely access. Antidote-specific online administration guidelines were developed. Using the poison centre for surveillance, the antidote program maintained a database of antidote utilization patterns; 11 years of data were available for analysis.
RESULTS: 2/2 (100%) tertiary care, 9/9 (100%) regional EDs, and 21/25 (84%) community EDs in Nova Scotia stock antidote kits, for an overall compliance rate of 32/36 (89%). A total of 678 antidotes (excluding N-acetylcysteine) were used for 520 patients. The distribution of antidote use by hospital type was 99/678 (14.6%) at community hospitals, 379/678 (55.9%) at regional hospitals, and 200/678 (29.5%) at tertiary care hospitals. The five most commonly used antidotes were: naloxone 143/678 (21.1%), fomepizole 111/678 (16.4%), glucagon 94/678 (13.9%), calcium 70/678 (10.3%), and sodium bicarbonate 67/678 (9.9%). Of the 520 patients in whom antidotes were used, death occurred in 3% (15/520), major outcomes in 35% (183/520), and moderate outcomes in 39% (205/520).
CONCLUSION: The Nova Scotia Antidote Program demonstrates that a solution to inadequate antidote stocking is achievable and requires a system-wide approach with ongoing maintenance and surveillance. The frequency and distribution of antidote usage documented in this program supports the need for enhancement of emergency preparedness. The poison centre and hospital pharmacies are crucial to surveillance and maintenance of this program.
Exemplary toxicological studies are presented to discuss the linearity assumptions of AOP, the management of event modifiers and compensatory mechanisms, and whether a separation of toxicodynamics from toxicokinetics including metabolism is possible in the framework of pathway plasticity. Suggestions on how to compromise between different needs of AOP stakeholders have been added.